My husband is scheduled for surgery this afternoon for a badly broken elbow (motorcycle accident). They are talking about taking one of the bones out at the top and replacing it with an implant. He's already signed the forms giving the surgeon permission to do whatever needs to be done. I'm wondering if that's such a good idea. Maybe we should go back and say, No, save the elbow no matter what. What do you think?
It sounds like he may have a broken and perhaps even dislocated radial head. The radius is one of two forearm bones that meet the humerus (upper arm bone) to form the elbow. The radial head is the top of the radial bone. It sits up under one side of the humerus and articulates (moves) against the other bone of the forearm (the ulna).
Orthopedic surgeons who specialize in the treatment of traumatic upper extremity injuries say there's no best way to treat a badly broken elbow. If it's dislocated and fractured into bits, it could be wired together. But it might be better to replace the elbow with an artificial replacement.
Today's current approach with a radial head fracture is to take all the individual patient-factors into consideration. Then look at current opinion of the experts and combine that information with any evidence available from published studies. The result is a set of guidelines to help with the decision. There isn't always a clear treatment path. In other words, one approach doesn't work for everyone.
That's why your surgeon has probably explained all the possible different ways to go and your husband has given permission for the final decision to be made in the operating room when the surgeon can see what he or she is dealing with.
The surgeon will evaluate the blood vessels and nerves to the area and see if there has been any damage there. Consideration will be given as to whether or not the patient has strong enough bones to hold pins, miniplates, screws, or wires necessary to hold the bone fragments together while it is healing. It is important that both bones of the forearm (radius and ulna) be kept equal in length. The surgeon must assess the entire arm for injuries in case there are other bones broken or torn soft tissues that might affect this relationship.
The more the bone is fragmented into pieces, the greater the chances that the patient will lose motion and function with any attempts at fixation. If the radial head is involved, forearm rotation is often compromised. And without the ability to rotate the forearm, the patient cannot turn the palm up, a movement called supination and palm down (pronation). The loss of forearm supination and pronation can be very limiting. Imagine trying to turn a key in the door, wipe yourself after going to the bathroom, or even carry a bowl of cereal without these motions.
Usually, surgeons will make every effort to repair complex, fragmented fractures of the radial head. No matter what decision is made, the goal is to restore forearm and elbow stability and motion.
Gabriel Clembosky, MD, and Jorge G. Boretto, MD. Open Reduction and Internal Fixation Versus Prosthetic Replacement for Complex Fractures of the Radial Head. In Journal of Hand Surgery. July/August 2009. Vol. 34. No. 6. Pp. 1120-1123.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.